Healthcare Provider Details

I. General information

NPI: 1972626968
Provider Name (Legal Business Name): ACUPUNCTURE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4964 WOODWARD GDNS
COLUMBIA MD
21044-1525
US

IV. Provider business mailing address

4964 WOODWARD GDNS
COLUMBIA MD
21044-1525
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-1750
  • Fax: 410-740-4330
Mailing address:
  • Phone: 410-740-1750
  • Fax: 410-740-4330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU00736
License Number StateMD

VIII. Authorized Official

Name: MS. SANDRA RUTH JOHNSON
Title or Position: PRESIDENT
Credential: LIC.AC.
Phone: 410-740-1750